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hlsc 222 final > Renal Disorders > Flashcards

Renal Disorders Flashcards

1
Q

Causes of a hyper-reflexia bladder with vesico - sphincter dyssynergia injury between C2 - s1?

A

Caused by SCI, MA Guillain-Barre syndrome, vertebral disc problems

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2
Q

Causes of an Acute Kidney Injury?(AKI)

A

Can be caused by myocardial infarct, hypotension, sepsis, shock, peritonitis, and extracellular volume depletion

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3
Q

What is Suppurative cystitis?

A

pus formation on the epithelial surface of the bladder – pus forming on the bladder wall

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4
Q

What two things does renal insufficiency and failure cause?

A

Uremia - urea and other waste products build up in the body because the kidneys are unable to eliminate them

Azotemia - kidneys are no longer able to get rid of enough nitrogen waste. – increased BUN – blood urea nitrogen

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5
Q

What is pyelonephritis? What can it result in?

A

bacterial infection causing inflammation of the kidneys

Colonization of bladder, reflux up into ureters to kidneys – pyelonephritis – can lead to acute kidney injury

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6
Q

What are the 3 phases of an acute Kidney injury?

A

1.) Oliguric phase
2.) Diuretic phase
3.) Recovery

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7
Q

What is a detrusor hyper-reflexia neurogenic bladder caused by? Where on the spinal cord is the injury?

A

Caused by stroke, TBI, MS, cerebral palsy, dementia (Alzheimer’s disease), and brain tumours

Above C2

(Overactive bladder causes you to have little or no control over your urination. It can also cause you to feel a sudden or frequent need to urinate. (It’s also called spastic or hyper-reflexive bladder))

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8
Q

What is post renal renal failure?

A

Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour, or injury

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9
Q

Characteristics of a hyper-reflexia bladder that’s above C2?

A

Above C2 – hyper-reflexia – urgency and urine leakage – bladder empties automatically when it is full

Urine leakage and incontinence

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10
Q

What vitamin does the renal system activate? What enzyme does it release?

A

Activities Vitamin D

Releases erythropoietin (which helps with the absorption of calcium and production of RBCs)

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11
Q

Characteristics of a hyper-reflexia bladder with injury between C2 - S1?

A

– hyper-reflexia with sphincter dyssynergia (dis se ner tia) – muscle contraction and external sphincter contraction occur at the same time = functional obstruction of the bladder

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12
Q

Risk factors for chronic kidney disease?

A

At risk are African-American descent, older age, low birth weight, family history
Smoking, obesity, HTN, and DM

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13
Q

What does the patient become like in the oliguric phase of an acute kidney injury?

A

patient become hypovolemic, edema, weight gain, HTN

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14
Q

Kidney failure Vs renal insufficiency (might be due to)?

A

Renal insufficiency - poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys – decline of 25%

Kidney failure - unable to filter waste products from your blood. – less than 10% remains

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15
Q

What is intrarenal renal failure? What is it caused by?

A

Direct damage to the kidneys with inflammation, toxin, drugs, infection, or reduced blood supply

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16
Q

What is Chronic pyelonephritis? what does it lead to?

A

Chronic pyelonephritisis continuing infection of the kidney – leads to scarring of one or both kidneys. – on going obstruction of some of the tube within our urinary system – if it’s not treated we are going to go into complete renal failure

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17
Q

What is Hydronephrosis?

A

– swelling of the kidney due to back up

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18
Q

What is hemorrhagic cystitis? What are some symptoms?

A

A condition in which the lining of the bladder becomes inflamed and starts to bleed. The blood can be seen in the urine. (Hemorrhagic cystitis – more advanced – inflammation has advanced – blood in urine)

Symptoms include pain and a burning feeling while urinating, feeling a need to urinate often, and being unable to control the flow of urine.

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19
Q

S+S for renal colic?

A

Renal Colic – moderate to severe pain in flank

– radiating to groin – indicates obstruction of renal pelvis or proximal ureter

Radiating to lateral flank or lower abdomen – obstruction of midureter

Urgency, frequency, urge incontinence – obstruction of the lower ureter

Pain can be severe accompanied by nausea and vomiting – hematuria may be present

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20
Q

Symptoms of chronic pyelonephritis?

A

Symptoms may be absent or may include fever, frequency, malaise, and flank pain.

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21
Q

What is Acute cystitis?

A

Inflammation of the bladder

Acute cystitisis a sudden inflammation of the urinary bladder. Most common urinary tract infection (UTI).

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22
Q

S+S of acute cystitis?

A

Reminder:Cystitis is inflammation of the bladder, usually caused by a bladder infection. It’s a common type of urinary tract infection (UTI)

S&S – most are asymptomatic, older adults at higher risk

Frequency, urgency, painful urination, and suprapubic and low back pain

Older adults may present as confused or vague abdominal discomfort

Increased mortality in older adults with recurrent infections

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23
Q

What does Pre-renal failure result in? what is it caused by?

A

Impaired perfusion – caused by cardiac failure, sepsis, blood loss, dehydration, vascular occlusion

24
Q

What is the main factor for formation of renal calculus?

A

pH of urine - >7.0 increased risk of calcium phosphate stone
< 5.0 increased risk of uric acid stone

25
Q

What is Mild inflammation with acute cystitis?

A

Where the inflammations starts in the process before going to hemorrhagic and supportive

26
Q

Risk factors for pyelonephritis?

A

Urinary obstruction and reflux of urine from the bladder most common risk factors.

Most cases occur in women

27
Q

Who is at the greater risk for developing a urethral stricture

A

Occur mostly in men, rarely in women

28
Q

In the oliguric phase of an acute kidney infection what level rise?

A

BUN and creatine levels rise – ratio of BUN to creatine falls from normal 20:1 to 10:1 –

29
Q

what are the 3 causes of Oliguria?

A

Reminder: Oliguria is defined as urinary output less than 400 ml per day or less than 20 ml per hour

Alterations in renal blood flow – efferent

vasoconstriction
Tubular obstruction – necrosis of the tubules causes sloughing of cells, cast formation, and ischemic edema

Tubular Back Leak:
-Tubular reabsorption is accelerated as a result of increased permeability caused by ischemia and increased pressure due to obstruction

30
Q

Charaterisitcs of an uncomplicated UTI?

A

Uncomplicated – asymptomatic, mild, without complications

31
Q

What does intrarenal renal failure result in?

A

Injury to the tubules that is most often is caused by ischemia or nephrotoxins.

1.) Glomerulonephritis (damage to the tiny filters inside your kidneys (the glomeruli), small vessel vasculitis, acute tubular necrosis (drugs, toxins, prolonged hypotension)

2.) Interstitial nephritis (drugs, toxins, inflammatory disease, infection)

32
Q

What is a complicated UTI?

A

compromised host defences – HIV, Kidney transplant, DM, spinal cord injury – have a lot of other things that could be causing it and could go into the GI tract

33
Q

Characteristics of Diuretic phase of an acute kidney injury?

A

Diuretic phase – 1-2 weeks – possibly longer – urine output ranges from normal to high

34
Q

What is chronic pyelonephritis associated with?

A

Chronic pyelonephritis or Recurrent infections may be associated with – occurs more frequently with renal infections associated with obstructive pathology

35
Q

What is pre-renal failure?

A

Sudden and severe drop in blood pressure(shock) or interruption of blood flow to the kidneys from severe injury or illness

36
Q

With hydronephrosis if there is a complete obstruction how long can It take for damage to occur?

A

If there is a complete obstruction damage can occur within hours, partial obstruction can take up to 2 months before function is irreversible

37
Q

Patho behind hydronephrosis?

A

Decreased GFR but Initially increased urine output as the kidney is not concentrating urine

Affected kidney can’t conserve sodium, bicarbonate, and water or excrete hydrogen or potassium = metabolic acidosis and dehydration

38
Q

What is the diuretic phase of an acute kidney injury caused by?

A

Caused by - kidney’s loses ability to concentrate urine & Osmotic diuresis produced by high BUN levels

39
Q

What is oliguria?

A

Urine output of <400ml/24hrs
Goal is 0.5-1.5ml/kg/hr

40
Q

Charateristics of an atonic bladder? Where does this injury on the spinal cord occur?

A

-Injury occurs below S2

– urine retention and distension - full bladder is sensed, but detrusor does not contract – underactive bladder – stress & overflow incontinence

41
Q

Causes of kidney stones?

A

Supersaturation of salt in urine
Growth through crystallization
Absence of stone inhibitors

42
Q

With UTI the urine is (blank) due to it trying to kill off the bacteria

A

Acidic

43
Q

Outcomes of chronic kidney disease?

A

-Acute cardiac event
End stage kidney disease
Disability
Reduced quality of life
Death

44
Q

What is a Urethral Stricture? What does it cause?
What is it caused by?

A

Scarring that narrows the urethra and restricts flow from urine from the bladder – caused by injury, infection, or surgical manipulation that produces scars

45
Q

What do we see in our patients who are currently in the Diuretic phase of an acute kidney injury? What deficits will they have?

A

Weight loss occurs and hypovolemia occurs in this stage due to increased urine output

Can produce deficits in potassium, sodium, and water

Going to see HUGE amounts of urine output – 3-5L a day – going to make tons of urine but can’t properly filter it

46
Q

At risk individuals for UTI’S?

A

At risk – premature infants, prepubertal children, sexually active and pregnant females, women treated with antibiotics that affect vaginal flora, post menopausal women, indwelling catheters, DM, neurogenic bladder, UT obstruction

More common in women than men due to shorter urethra closer to anus

47
Q

What can supportive cystitis cause?

A

Severe cases can cause sloughing of bladder mucosa with ulcer formation or possible necrosis of the bladder wall

48
Q

Risk factors for kidney stones

A

Age, gender, ethnicity, geographical location, fluid intake(how hydrated are you), diet, occupation
Geographical – temperature, humidity, and rainfall – and influence on dietary patterns
Classified – by composition

49
Q

What is CKD (Chronic kidney disease) associated with? What is the result of?

A

Associated with systemic disease such as DM, HTN, lupus- any automine can damage the kidneys and send a person into the chronic phase

Can also be the result of intrinsic kidney disease from glomerular, vascular, or tubular disease – acute kidney injury progresses to chronic kidney disease

50
Q

What are the 5 stages to chronic kidney disease? What are we going to see at each phase?

A

1 – kidney damage with normal kidney function – GFR > 90 – asymptomatic – may have HTN

2 – kidney damage with mild loss of kidney function – GFR 60-89 – subtle changes – HTN, increasing Creatine and Urea

3 – mild to moderate loss of kidney function – GFR 30-59

4 – Severe kidney damage – GFR 15-29 – metabolic acidosis, hyperkalemia, salt or water retention,

5 – end stage kidney disease (ESKD) – GFR < 15 – need treatment – dialysis or transplant to live

51
Q

Where are kidney stones located? Are they unilateral or bilateral?

A

Located in kidneys, ureters, and bladder
Unilateral

52
Q

Causes of Acute pyelonephritis?

A

kidney stones, vesicoureteral reflux(urine flow back up to kidneys), pregnancy, neurogenic bladder, catherization, endoscopes, female sexual trauma

53
Q

What happens if Chronic pyelonephritis goes left untreated?

A

– on going obstruction of some of the tube within our urinary system – if it’s not treated we are going to go into complete renal failure

54
Q

Characteristics of the oliguric phase of an acute kidney injury?

A

Onset of 1-7 days

– 1-7 days (going to start treating the problem within this timeframe)

-Decreased urine output because kidneys aren’t functioning as well as they should be

Affects BP, Toxin levels, acid-base balance, activates vitamin D so it can stimulate absorption of calcium,
Fluid overload

55
Q

Charateristics of the recovery level of an acute kidney injury

A

Final stage

BUN and creatine levels have returned to normal

Urine output has returned to normal

56
Q

What is Acute pyelonephritis? What area of the urinary tract does it effect?

A

Acute pyelonephritisis a sudden and severe kidney infection. Effects one or both of the upper urinary tracts – can be caused by a blockage, infection alone – biggest cause is Kidney stones

57
Q

What is an acute kidney injury? What does it commonly occur as a result of?

A

-AKI is a sudden decline in kidney function with a decrease in glomerular filtration and urine output with the accumulation of nitrogenous waste products in the blood as demonstrated by an elevation in plasma creatine and BUN levels

-Commonly occurs as a result of ischemic damage to renal tubular epithelial cells (RTECs)

hlsc 222 final (5 decks)

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